Early Pregnancy Flashcards
When is a heartbeat detectable in a fetus?
TVUSS - 6 weeks.
What is the definition of a miscarriage? When do most occur?
Fetus dies or delivers dead before 24wks.
The majority occur before week 12.
What are the types of spontaneous miscarriage?
Threatened: Bleeding, but fetus still alive, uterus the expected size and os closed. 25% miscarry.
Inevitable: Heavy bleeding, open os.
Incomplete: Some fetal parts passed, os open.
Complete: All fetal tissue passed, bleeding diminished, uterus small and os closed.
Missed: Fetus hasn’t developed or has died inutero. Not recognised until bleeding / scan occurs. Small uterus, os closed.
Septic: Contents infected, causing endometritis. Offensive vaginal loss. Tender uterus.
How would you investigate a spontaneous miscarriage?
USS. Fetal heart beat is reassuring - 90% will not miscarry. If any doubt due to being early in pregnancy, repeat a week later.
HCG level. Should increase by >66% in 48h for viable intrauterine pregnancy.
How would you manage a miscarriage?
Anti-D if RH-ve, >12wks, medical or surgical management.
Expectant: if woman is willing and no infection, usually takes 2-6wks.
Medical: Vaginal prostaglandin (misoprostol).
Surgical: ERPC.
What are the complications associated with treatment of miscarriage?
Vaginal bleeding with expectant or medical. Can be heavy so need rapid access to healthcare.
Infection.
Asherman’s syndrome with surgical.
Perforation with surgical.
What is the definition of recurrent miscarriage?
3 or more miscarriages in a row.
What are the common causes of recurrent miscarriage?
Antiphospholipid antibodies. Ab screen to investigate, treat with aspirin and LMWH.
Chromosomal defects. investigate by karyotyping.
Anatomical abnormalities. USS to investigate.
What are the methods of termination of pregnancy?
Medical: mifepristone (orally), 36-48h later misoprostol (vaginally). Up to 21+6. Feticide required after 21+6 then proceed.
Surgical: suction appropriate for 7-15wks, above 15wks dilation and evacuation.
How does an ectopic pregnancy present?
Indicators: abnormal bleeding, abdo pain, collapse.
Lower abdo pain (colicky then constant) followed by dark vaginal bleeding.
O/E: uterus smaller than expected for dates, abdo and adnexal tenderness, cervical excitation.
How would you investigate an ectopic pregnancy?
Pregnancy test!
TVUSS. If no intrauterine pregnancy visible, then <5wks, miscarried, or ectopic.
Serum HCG level. >1000 should be visible on USS. If lower, but increases >66% in 48h then likely intrauterine.
How would you manage a ?ectopic?
Admit if symptomatic.
IV access, cross match, Anti-D if RH-ve.
If unstable: resuscitation and surgery.
If stable: laparoscopy + salpingostomy / salpingectomy. Or if unruptured, no cardiac activity and hcg<1500 - single dose methotrexate.
What is hyperemesis gravidarium?
N&V so severe that it causes dehydration / weight loss / electrolyte disturbance.
How do you manage hyperemesis gravidarium?
It spontaneously resolves by 14 wks normally.
In between - rehydrate with electrolytes and give antiemetics (metaclopromide / ondansetran) and thiamine.
How does gestational trophoblastic disease present?
Vaginal bleeding, severe vomiting.
